Cascade of care during the first 36 months of the treatment as prevention for hepatitis C (TraP HepC) programme in Iceland: a population-based study.

• Published in: The Lancet Gastroenterology & Hepatology
• Main Authors: Olafsson, Sigurdur, Fridriksdottir, Ragnheidur H, Love, Thorvardur J, Tyrfingsson, Thorarinn, Runarsdottir, Valgerdur, Hansdottir, Ingunn, Bergmann, Ottar M, Björnsson, Einar S, Johannsson, Birgir, Sigurdardottir, Bryndis, Löve, Arthur, Baldvinsdottir, Gudrun E, Hernandez, Ubaldo Benitez, Gudnason, Thorolfur, Heimisdottir, Maria, Hellard, Margaret, Gottfredsson, Magnus
• Other Authors: 1Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland. Electronic address: [e-mail]. 2Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 3Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland. 4SAA National Center for Addiction Medicine, Reykjavik, Iceland. 5Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavík, Iceland; SAA National Center for Addiction Medicine, Reykjavik, Iceland. 6Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland. 7Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 8Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland. 9Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 10Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 11Directorate of Health, Reykjavik, Iceland. 12Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland; Icelandic Health Insurance, Reykjavik, Iceland. 13Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia. 14Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2021
• Subjects: Lifrarbólga C; Hepatitis C; Antiviral Agents; Iceland; Population Surveillance
• Online Access: http://hdl.handle.net/2336/621941; https://doi.org/10.1016/S2468-1253(21)00137-0

To access publisher's full text version of this article click on the hyperlink below Background: WHO has set targets to eliminate hepatitis C virus (HCV) infection as a global health threat by 2030 through a 65% reduction in HCV-related deaths and 80% reduction in HCV incidence. To achieve these goals, WHO set service coverage targets of 90% of the infected population being diagnosed and 80% of eligible patients being treated. In February, 2016, Iceland initiated a nationwide HCV elimination programme known as treatment as prevention for hepatitis C (TraP HepC), which aimed to maximise diagnosis and treatment access. This analysis reports on the HCV cascade of care in the first 3 years of the programme. Methods: This population-based study was done between Feb 10, 2016, and Feb 10, 2019. Participants aged 18 years or older with permanent residence in Iceland and PCR-confirmed HCV were offered direct-acting antiviral (DAA) therapy. The programme used a multidisciplinary team approach in which people who inject drugs were prioritised. Nationwide awareness campaigns, improved access to testing, and harm reduction services were scaled up simultaneously. The number of infected people in the national HCV registry was used in combination with multiple other data sources, including screening of low-risk groups and high-risk groups, to estimate the total number of HCV infections. The number of people diagnosed, linked to care, initiated on treatment, and cured were recorded during the study. This study is registered with ClinicalTrials.gov, NCT02647879. Findings: In February, 2016, at the onset of the programme, 760 (95% CI 690-851) individuals were estimated to have HCV infection, with 75 (95% CI 6-166) individuals undiagnosed. 682 individuals were confirmed to be HCV PCR positive. Over the next 3 years, 183 new infections (including 42 reinfections) were diagnosed, for a total of 865 infections in 823 individuals. It was estimated that more than 90% of all domestic HCV infections had been diagnosed as early as ...